CAP/DA is a Medicaid Home- and Community-Based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-Based Waiver Services.
The waiver program provides a cost-effective alternative to institutionalization for a Medicaid beneficiary who is medically fragile and at risk for institutionalization if home and community-based services approved in the CAP/DA waiver were not available. CAP/DA services allow the beneficiary to remain in or return to a home and community-based setting by supplementing, rather than replacing, the formal and informal services and supports already available to an approved Medicaid beneficiary.
Consumer-direction is a service delivery model that allows a CAP/DA Medicaid beneficiary or designated representative to act in the role of employer of record to direct their personal care services by:
Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.
If you are a CAP/DA case management entity or a qualified home-and community-based provider, a referral can be completed in the e-CAP system.
A referral may also be made by calling 833-522-5429 or faxing the completed referral form to 833-470-0597.
Community Alternatives Program for Disabled Adults Waiver Renewal Survey and Informational Session Registration
Renewal of the Community Alternatives Program for Disabled Adults 1915(c) Home and Community-Based Services Waiver
The North Carolina Community Alternatives Program for Disabled Adults (CAP/DA) §1915(c) Home and Community-Based Services (HCBS) will expire Oct. 31, 2024. North Carolina is seeking to renew its waiver for another five years to ensure continuous access to the program’s services.
The CAP/DA waiver is a statewide program that offers services to physically disabled adults and individuals over 65 who meet a nursing facility level of care. The program offers 18 home and community-based services to a total of 11,648 recipients. Program enrollees must have a need for at least one of the 18 available home and community-based services to remain in or return to a community setting.
Below is the proposed timeline for the renewal waiver.
CAP/DA Waiver Renewal Activities
February – May 2024
To register for the Listening Session, click here then follow the prompts to complete your registration.
April – May
June – July 2024
August – October 2024
CAP/DA Standard Operating Procedures
NC Medicaid Clinical Section
Phone: 919-855-4340
Fax: 919-715-0052
Email: medicaid.capda@dhhs.nc.gov
The Community Alternatives Program for Disabled Adults Waiver Application was submitted to The Centers for Medicare & Medicaid Services (CMS) Trareview and approval on March 1, 2019.
Click here to view the CAP/DA Renewed Application.
NC Medicaid has requested from CMS an extension period to continue to administer the CAP/DA waiver through CMS’ review and approval process.
During the public comment period (Jan. 4 – Feb. 4, 2019), a total of 300 comments were received. From those comments three (3) sections were updated in the draft waiver application, Appendix B, C and D. The updates were made only to provide additional clarity; the intended business processes were not changed. Click here to view a summary of the comments.
During the month of June 2019, NC Medicaid Long-Term Services and Supports held a Community Alternatives Program for Disabled Adults (CAP/DA) Home- and Community-Based Services (HCBS) waiver orientation and educational training for CAP/DA HCBS providers.
Training provided an in-depth overview of the newly implemented workflow and business steps to render CAP/DA services as outlined in the renewed CAP/DA HCBS waiver application and the amended CAP/DA Clinical Coverage Policy, 3K-2.
The CAP/DA unit within NC Medicaid held informational webinars for stakeholders in Jan. 2019 to learn about the proposed changes included in the waiver application and gave stakeholders an opportunity to make comments.
Comments pertaining to the renewal CAP/DA waiver application may also be forwarded to Medicaid.capda@dhhs.nc.gov or by calling 919-855-4343. An electronic version of the renewal application is available on the NC Medicaid, NCTracks and e-CAP websites and a paper version can be accessed at each county Department of Social Services office.
NC Medicaid engaged stakeholders through statewide listening sessions, focus groups, work sessions, public comments and information sharing. The recommendations gathered from these stakeholder engagements informed the design of the proposed renewal CAP/DA HCBS waiver.
The 1915 (c) Home and Community-Based Services Waiver for the Community Alternatives Program for Disabled Adults (CAP/DA) is scheduled to expire on Sept. 30, 2018. The NC Division of Medical Assistance (DMA) must submit a waiver renewal application to the Centers for Medicare and Medicaid Services (CMS) no later than June 1, 2018, 90 days prior to the expiration of the waiver, to ensure the continuation of the waiver. In addition to the waiver renewal application, the Clinical Coverage Policy, 3K-2, Community Alternatives program for Disabled Adults (CAP/DA), will be revised to support the clinical operation of CAP/DA.
Focus Group Q | Focus Group CC | Focus Group S | Focus Group E |
---|---|---|---|
Primary objective is to design the waiver Quality Improvement Strategies and Continuous Quality Improvement Initiatives | Primary objective is to identify case management activities and timeliness; safeguards for interest-free case management and eligible providers of CM/HCBS and required responsiblities of partnering entities. | Primary Objective is to identify and define HCBS services to maintain and promote community integration civen the changing needs of target population | Primary ojective is to identify and define waiver entry eligibility, health, safety and well-being criteria |
North Carolina Medicaid held annual training and educational sessions in consumer-direction during the months of July and August 2018. The annual trainings were for individuals currently participating in the consumer-direction program and for those individuals interested in participating in the consumer-direction program. The educational and enrichment trainings will consist of:
Listening sessions were held across North Carolina from Oct. 24 through Nov. 8, 2017
Summary of trends from comments:
The Division of Medical Assistance held five (5) listening sessions across North Carolina to allow interested stakeholders to participate in a collaborative dialogue focused on key areas of the waiver renewal. These sessions were held in the months of March and April in the cities of Raleigh, Kannapolis, Lenoir, Hendersonville and Greenville , and included 125 stakeholders.
During the sessions, focus groups concentrated on topics to determine how well the programs are working, areas for improvement, and creative ways to meet the needs of patients who receive CAP/DA services. Common comment trends included:
Many of the participants commented that they found the sessions engaging and that the groups allowed for a more focused dialogue and the opportunity to hear creative thoughts and other opinions. The comments from these listening sessions will be incorporated in the renewal application for the CAP/DA HCBS waiver, which will expire on Sept. 30, 2018.
Effective Feb. 5, 2017, N.C. Division of Medical Assistance (DMA) implemented a prior approval (PA) process for the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) home and community-based services waivers for Level Of Care (LOC) and CAP waiver services. A PA record was created and electronically transmitted to NCTracks for each new LOC determination decision made after Feb. 5, 2017, and for each currently approved CAP waiver service for all currently eligible CAP beneficiaries. Click here for more information.
Effective March 2017, a Direct Service Provider( DSP) Interface was implemented to streamline CAP/DA case management processes in the areas of eligibility, service plan development and authorization and care coordination. Direct Service Providers authorized to provided CAP/DA services must register to be a DSP user of the e-CAP system by accessing this link.
February 21, 23, 27 and 28, 2017 - DSP Waiver Objectives